DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION 1 INSTRUCTION FOR CANDIDATE This woman is reporting to the gynaecology clinic in Komfo Anokye Teaching Hospital (KATH) for the first time today, with a complaint. You are to take a history from her. At the end of the history, you will present a summary.DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION 1 ‘ GUIDE TO SIMULATOR HISTORY Mrs J. Y, 35-year-old banker, has presented with 2-year difficulty in trying to conceive. She presented to a private hospital about 6 months ago. Her investigations so far Se pelvic ultrasonography (scan). veh. vw we ’ On direct questioning oA pf ww er i She has no visual changes\galactorrhea, heat intolerance or intolerance for col weather. There is no deep dyspareunia (pain during sex), abnormal vaginal discharge or inter-menstrual bleeding. She has no excessive haif growth or deepening of her voice. | ¢ ¢ Systemic Inquiry There is nothing of significance in cardiovascular, gastrointestinal, genito-urinary, respiratory, musculoskeletal or CNS. Gynaecologic history: Menarche at 13 years, cycles are 4/28, are regular with moderate flow, no dysmenorrhoea. The LMP was 16" JULY, 2021. Coitarche at 18 years; She has had 3 lifetime sexual partners. Never used modern form of contraception Never been screened for cervical or breast cancer. | She is Para 0 + 1 termination of pregnancy. The pregnancywas terminated by D&C at 2 months gestation about 10 years ago. There were no post-abortion complications. The reason was she was not ready to raise a family. It was done in a private hospital. = be Gnaeve 4 Mr) Teel howe ceeer Aone, ab hot gertahon- hove long aye ~ POE abehen Compliehens " Gar apenc fe BAC ere SS weal yPAST MEDICAL AND SURGICAL HISTORY There is nothing of significance: there is no hypertension, diabetes, si hypertensior diabetes, disease etc. She has never been hospitalized or given blood transfusion. She has = eo never had any other surgery aside the D&C. DRUG HISTORY There is no drug or food allergy. Her medications consist of folic acid and Vitamin E. She has not used herbal medication, either orally or otherwise. FAMILY HISTORY There is nothing of significance SOCIAL HISTORY She works in a bank. She lives with the husband and sexual frequency is 2-3 times a week. The husband is 38 years old and works as an IT specialist. She and the husband do not drink alcohol or smoke cigarettes. They have not achieved pregnancy before. He has no child outside this relationship. There is no presence ‘of domestic violence and the relationship is not strained. The husband has no perineal/groin surgery and no history of mumps in adulthood. _DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION1 OSCE STATION ~ HISTORY INDEX NUMBER: ACTIVITY 1. Greeting the client. Self introduction with the explanation of purpose of the interaction. ~ Demographic features: i Name Age and Address. — 3. Gravidity & parity uv — 5. Presenting Complaint(s) Inability to conceive 6. HPC Duration of trying to conceive 2 years What has been done in other facility about the complaint ie USG 7. 0p Visual changes — Galactorrhea Dyspareunia— ‘Symptoms of thyroid disease (heat or cold intolerance) Hirsutism (excessive hair growth) 8. System review — Cardiovascular Respiratory Genito-urinary Gastrointestinal Musculo-skeletal CNS 9. Gynaecological history ‘Age of Menarche Menstrual Cycle (length of cycle, duration of flow) Dysmenorrhea Use of contraceptives Cervical cancer screening Breasts Screening Previous STI Coitarche Number of all time sexual partners Coital frequency and interval 10. Past obstetric history Only pregnancy: year Gestation terminated Outcome (induced abortion) Post-abortion complication Reason for TOPWhere TOP was done 11. Past Medical / Surgical History: Any significant medical history. No hypertension, diabetes, sickle cell, thyroid disease, asthma (any two) 12. Drug history: Food and drug Allergies _No use of herbal medication 13. Family History = ‘Significant medical conditions in family (hypertension, diabetes, sickle cell ease, SLE, any two) Marital status and Occupation of patient Use of alcohol/tobacco Living together or apart? Husband: his age Occupation of husband Use of alcohol/tobacco History of mumps in husband as a teenager/adult Previous surgery in husband especially groin/perineal surgery Number of children of husband outside this relationship . Summary of history (presenting complaint, duration of infertility, previous work-up and relevant gynaecological history ‘35-year old banker para 0 +1 TOP presenting with 2-year inability to ‘conceive. Pelvic ultrasound scan was normal and no other evaluation has been done. ~ _ - Thank you courtesies (1 mark) Total Marks per column ae Grand Total so “| TOTAL ATTAINABLE MARKS: 75 EXAMINER'S NAME/SIGNATURE:DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION 2: POST-ENCOUNTER SCENARIO FOR CANDIDATE This woman is reporting to the gynaecology clinic at Komfo Anokye Teaching Hospital. She is Mrs J.Y, 35-year-old banker, has presented with 2-year difficulty in trying to conceive. She presented to a private hospital about 6 months ago. Her investigations so far included pelvic ultrasonography (scan). She is Para 0 + 1termination of pregnancy. She lives with the husband and sexual frequency is 2-3 times a week. The husband is 38 years old and works as an IT specialist. She and the husband do not drink alcohol or smoke cigarettes. They have not achieved pregnancy before. INDEX NUMBER: QUESTIONS [ol Tz [4] Question 1. : ] ‘What is your diagnosis for the couple and why? — © Primary Infertility/Sub fertility) - 2.0 ‘* No pregnancy achieved between the couple ~ 2.0 x x Question 2. How would you find out if this woman is ovulating ? | (2 marks for each: candidate to briefly explain each for full marks) | | «Regular monthly cycles with mid-cycle pain (Mittleschmerz) x Basal body temperature x Cervical mucus testing | x Request 21-day serum sample for progesterone level | | x Luteal phase endometrial biopsy | x Ultrasound detection of disappearance of dominant follicle \x LH test kit to determine the pre-ovulatory LH surge | x Question 3. | Briefly explain the methods for assessing tubal patency? | @ HSG 4/- fluoroscopy - (4 marks) jx | = = a Eke+ laparoscopy with dye test — (4 marks) © HyCoSy—(2 marks) CC 1S f * Saline infusion sonography-Sis (2 marks) Question 4. If no cause of the infertility is found, what counsel would you give the couple? * Tocontinue trying for pregnancy (2 marks) © Offer ART (2 marks) * Adoption (2 marks) Question 5. | Give four methods of assisted reproductive techniques and explain the | basic principles of the most common method used in Ghana. | IVF-ET- (2 marks) vif ICSL-ET- (2 marks) Inte Cysteqolrme sper Ifo Sin GIFT- (2 marks) Commaex (hr fe Hew fore n fe ZIFT- (2 marks) — Lyset (IV Basic principles of IVF: 0 Pre-treatment evaluation of couple Controlled ovarian stimulation | Fertilization and incubation ZR Follicular monitoring pene! i ; | Oocyte retrieval NC sy & Embryo transfer & | Luteal support iy. yw Pregnancy test wt Y fotal Marks per column | Grand Total TOTAL ATTAINABLE MARKS: 60 EXAMINER'S SIGNATURE/NAME: af / xX xxx KKK KXDRY OSCE RUN CLASS OF 2021 INSTRUCTION TO THE CANDIDATE This woman has been referred from a midwife’s clinic to KATH. You are to take a history from her. At the end of the history taking, you will present a summary. OBSTETRICS: OSCE STATION—1 HISTORY SIMULATOR’S HISTORY HISTORY This is 30 year old SM, G3P2 at 33 weeks of pregnancy. She was referred from a maternity home with a history of unprovoked vaginal bleeding six hours ago. She has no abdominal pain and can feel fetal movement. Her BP is 120/80mmHg Presenting complaint Vaginal bleeding of 6 hours duration History of presenting complaint She noticed bleeding as she went about her normal chores this morning. She reported at her midwife’s clinic and was immediately referred to KATH. She has no lower abdominal pain and can perceive fetal movements. Current Pregnancy Pregnancy was planned. She booked at a private midwife's clinic at 4 months. She does not remember her LMP but ultrasound at booking gave the EDD as September 13, 2021. Booking investigations were all normal. Quickening was at 5 months. She has received two doses of malarial prophylaxis with sulphadoxine-pyrimethamine, She has had a shot of tetanus toxoid. _ The pregnancy has been uneventful till today when she started bleeding per vaginam. Direct Questioning She has changed sanitary pad twice. No passage of aids. No dizziness (no palpitations/n0 lower abdominal pains. There is no change in the fetal kick pattern.Systemic enquiry- not significant Past Obstetric history First pregnancy in July 2011, was uneventful and carried to term. Labour was spontaneous and the outcome was a live!male weighing 3.2kg. The baby is alive and well. / Second pregnancy in August 2014; was uneventful and carried to term. Labour was spontaneous but caesarean section was carried out on account of fetal distress. Outcome was @ livelfemale, weight 3.0kg. The puerperium was normal. The baby is alive and well... Gynecological history Menarche was at 14 years. Menstrual cycles regular 5/30, with moderate flow and no dysmenorrhea. Coitarche -20 years; one life-time sexual partner. She uses COC contraception between pregnancies. Has not been diagnosed of any STI. Has had breast examination and cervical screening for premalignant lesions. Results were normal.. Past Medical and Surgical History: Nothing of significance apart from the caesarean section. Drug history: She is on routine antenatal drugs. She has no drug allergies and does not use herbal drugs. Family history: Her father is hypertensive, No history of twins Social history: A trader married to a mechanic. They live in their own self-contained apartment with potable water and toilet facilities. Neither of them smokes nor drinks alcohol.DRY OSCE RUN CLASS OF 2021 OBSTETRICS: OSCE STATION 1 HISTORY CANDIDATE'S INDEX NUMBER. ACTIVITY 7 7 = o ja Greeting client, self-introduction and explaining purpose of x |interaction [ lL Demographic features Name & age- 7 x © Gravidity&parity- x *_UNMP _ _ x © EDD & EGA a Presenting complaint--- - =] X History of presenting complaint —Unprovoked vaginal bleeding 6 hours ago, reported to her midwife, subsequent referral to KATH | ON DIRECT QUESTIONING le ‘© Moderate bleeding (changed sanitary pads twice, no clots x passed) a eile * _Noassociated abdominal pain a # _ Still feels fetal movement |__« First episode of bleeding in this pregnancy SYSTEMIC ENQUIRY | [© Cardiovascular (Dizziness/palpitations ) Px © Respiratory; | [x Gastrointestinal- i = Ix] Genitourinary : IE CNS = |x HISTORY OF CURRENT PREGNANCY [ © Pregnancy is planned x |e When was booking visit Ix © Investigations at booking [x © Quickening ‘x--Nil of significance # IPT given and doses x © Tetanus toxoid given and doses x PAST OBSTETRIC HISTORY 7 a) ‘© First pregnancy—when and ANC x Mode of delivery and outcome- es ‘© Puerperium (normal/abnormal}- \* © Second pregnancy—when and ANC a | Mode of delivery (C/S), indication and outcome © Puerperium (normal/abnormal) x ‘i paca _ | GYNAECOLOGIC HISTORY | a Cycle length and duration of flow x © Presence or absence of pain ie © Goitarche x © Number oflifetime sexual partners ix | © Screening for breast masses and premalignant cervical x | lesions ‘© Contraceptive history _ ix | PAST MEDICAL & SURGICAL HISTORY x FAMILY HISTORY © Occupation Father is hypertensive x T * No history of twins x ‘SOCIAL HISTORY . © Marital status x x © Drug allergies Husband's occupation x ‘House amenities ly Tobacco use/alcohol use x | DRUG/MEDICATION HISTORY «Routine ANC drugs x Use of other drugs/herbs % | |x |© IPT, doses * Tetanol | Please give a summary of the history, dwelling on salient features— 2.0 | Name, age, parity, previous C/S + indication, uneventful pregnancy till 6 hours when referred from maternity home with painless, unprovoked bleeding per vaginam at 33 weeks. Feels fetal movement. ~ | Total per column ity mark with reasons [GRAND TOTAL Z a TOTAL ATTAINABLE MARK: 55. EXAMINER SIGN/NAME:____ © IPT doses Tetanol Please give a summary of the history, dwelling on salient features— 2.0 Name, age, parity, previous C/S + indication, uneventful pregnancy till 6 hours when referred from maternity home with painless, unprovoked bleeding per vaginam at 33 weeks. Feels fetal movement. ~_ = Total per colu Penalty mark GRAND TOTAL TOTAL ATTAINABLE MARK: 55 EXAMINER SIGN/NAME:DRY OSCE RUN CLASS OF 2021 OBSTETRICS: OSCE STATION 2 POST-ENCOUNTER EXAMINER’S INSTRUCTIONS This is 30 year old SM, G3P2 at 33 weeks of pregnancy. She was referred from a maternity home with a history of unprovoked vaginal bleeding six hours ago. She has no abdominal pain and can feel fetal movement. Her BP is 120/80mmHg Please use the checklist to appropriately score the candidate based on the above history.DRY OSCE RUN CLASS OF 2021 OBSTETRICS: OSCE STATION 2 POST-ENCOUNTER CANDIDATE INDEX NUMBER: AcTI QUESTIONS se : ofa [2 [a QUESTION 1 + What is the likely diagnosis? — APH due to placenta praevia i x Why? painless vaginal bleeding in late pregnancy x "QUESTION 2 As the doctor in the emergency room, what measures will you | | | take if you saw this patient? a) Explain to her the possible diagnosis and the need for admission into hospital b) Set up IV Normal Saline with a wide bore cannula x ¢) Do physical examination—BP, pulse, pallor, listen to FHR, no vaginal exan ation | a) Take blood samples fr grouping & cross-match against 4 units of blood e) Admit to the ward f) request ultrasound scan (pufrins oo PAS x | 8) Inform the emergency team on duty, | "QUESTION 3 | Discuss the inpatient management of this patient till delivery ‘© Optimize Hb if anaemic ee # Administer steroids to enhance fetal lung maturation | ¢ Bed rest «Ensure blood has been saved for her in case of emergency | delivery | «Daily fetal monitoring with fetal kick count * Twice weekly CTG poeemedned ie x x Be Curlee ee boy Sep evs we val Feta, Lun SS afehenk chesney ed uth Comte G.[+ _Weekiy to2 weekly BPP | QUESTION 4 : = _ How will you manage this patient's delivery? 1. Ifno further bleeding, wait till she is 38 weeks, then deliver by c/s If any life-threatening bleeding, urgent C/S C/S must be done by a more experienced doctor Paediatrician must be around to resuscitate baby Group and cross-match at least 4 units blood o{alelels Prevent primary PPH by use of oxytocin and misoprostol, if needed 7. Monitor the 4" stage of labour closely, observing for any abnormal vaginal bleeding Total percolumn Penalty mark with reasons GRAND TOTAL TOTAL ATTAINABLE MARK: 48 EXAMINER SIGN/NAME:DRY OSCE RUN CLASS OF 2021 SUPPLEMENT OBSTETRICS: OSCE STATION 1 INSTRUCTION TO THE CANDIDATE This woman has been referred from a midwife’s clinic to KATH. You are to take a history from her. At the end of the history taking, you will present a summary. iapmor at L bh, &cA BE on sk Cob ve 6DRY OSCE RUN CLASS OF 2021 GUIDE TO SIMULATOR HISTORY This is Miss SA, a 36-year old G2P1 + 0, referred as having high BP by her doctor to KATH. Her only delivery was 8 years ago. She remarried 6 years ago. She has no complaint today. BP on referral is 160/105mmHg. Presenting complaint Has no complaint Systemic enquiry Nil of significance Present Pregnancy She has been treating infertility a a private clinic for past S years. Pregnancy is a wanted one LIMP: 30" NOV 2020. eb ia |> 2 ehh 24|* oe{ 22> 2 She booked at the private clinic at 6 weeks. ead BP was a Booking «27 Of investigations are normal; ultrasound scan agrees with her dates -Jeickening at 5 months; has continued to feel fetal movements Has had 3 doses of SP, the last one at 32 weeks Had a single shot of TT injection at booking She has been well throughout this pregnancy and presented this morning for routine antenatal care at her midwife’s clinic and was then referred to KATH. Currently on routine ANC drugs Past Obstetric history She is G2P1+0 1" pregnancy—9 years ago. Had regular ANC at Manhyia Hospital; pregnancy was uneventtul, carried to term. She had a spontaneous delivery at Manhyia Hospital. Outcome was male, 3.1kg. Puerperium was uneventful. Exclusive breastfeeding done for 6 months.Gynaecologic history r ~ Menarche at 12 years, regular cycles 5/30, moderate floyx, no pains/no passage of dots’ Coitarche at 16 years; Infertility treatment for past 5 years at a private clinic. ‘Has had HSG and endometrial biopsy done. Was told everything was normal. Husband was given some medication after a semen analysis. She has not been screened for premalignant lesions of cervix or for breast masses. Never used any form of contraception. She's not been diagnosed of any STIs. Past medical history There is nothing of significance. No drug allergies Family history Mother is a hypertensive. Elder sister has had a twin delivery Social history She is a trader in second-hand clothing. Has had 3 lifetime sexual partners. Has been with current partner for past 6 years. Husband is a businessman, They live in their own house that has toilet and bath facil ies. They use pipe-borne drinking water. Husband is a social drinker but does not smoke. She neither smokes nor drinks.DRY OSCE RUN CLASS OF 2021 OBSTETRICS OSCE STATION-1. INDEX NUMBER. ACTIVITY (Ont 2s . — : e| Basic courtesies. Greeting client, Self-introduction, explanation of purpose of | |X | | interaction- 1.0 | Demographics: Name, age, etc 1.0 Gravidity/ Parity. LNMP-- 1.0 Do) | x EDD-— 2.0 ik | EGA— 2.0 Re Presentation---- 1.0 a |x History of presentation— 1.0 x Direct questioning—5.0. iP | Headaches ~ Blurred vision Y x x Epigastric pain ~/ x Fetal movements ~ x x Vomiting _/ | Systemic review " Cardiovascular—1.0 Respiratory---1.0 0 GIT- Genitourinary---1.0 | Musculoskeletal---1.0 x) x) x x) x) x | CNS--1.0History of current pregnancy J Witertility treatment—1.0 . x _) Planned / Wanted or not-~1.0 | x | ‘| Booking visit—1.0 x Results of investigations at booking—1.0 |x | When was quickening?— 1.0 1 x Any fetal movements today?--- 1.0 x BP found to be high today 2.0 | IPT given and doses ; [Total 1.0 Sh Tetanol injection given-- 1.0 Drug use: routine ANC drugs--1.0 y Past obstetric history 7 “1 pregnancy: when- Outcome and Puerperium---1.0 [Total—4.0] /ANC- 1.0; where delivered—1.0 Gynaecological procedures; EB (1.0), HSG (1.0) Past Medical/ Surgical History Nil of significance--1.0 72 - cy | Gynaecologic History - Menarche 1.0 aa "Menstrual cycle—1.0 | ‘Any associated pain or not—1.0 x Excessive flow or passage of clots—1.0 ik 1 | ‘Screening for premalignant lesions of cervix—1.0 [a] Screening for breast masses—1.00 i | | Tage at coitarche—1.0 a | Lifetime sexual partners—1.0 x "Contraceptive history—1.0 : = a ‘Any other diagnosed STIs—1.0Family History "Mother is hypertensive (1.0), Sister has twins (1.0) x Social History Occupation of patient---1.0 Occupation of husband---1.0 | Husband a social drinker—1.0 [* Me ela | Patient does not drink or smoke—1.0 x Place of residence and amenitie: aol ep Please give a summary of your history, dwelling on salient |_| | | features.NAME, AGE, GAVIDITY, PARITY, REFERRED AS HIGH | | x | | | | BP, NO COMPLAINT, AT 34 WEEKS, INFERTILITY | | | | TREATMENT(1.0 each; Total—4)_, | a - | | Total per column | Penalty mark with reasons | GRAND TOTAL SCORE TOTAL MARKS ATTAINABLE Examiner's Name and signature:DRY OSCE RUN CLA‘ SOF 2021 STATION 2: POST ENCOUNTER sypPLEMENT Score the candidate using this checklist 1 | | Question o1 (2 4 | QUESTION 1; Outline your initial management of this | | patient. | 1. Admit patient - 2.0 xv 2. Check BP to confirm elevation --2.0 x 3. Start antihypertensives —Hydralazine IV or Labetalol, Xv followed by oral Nifedipine, Methyldopa (2.0) 4, Monitor BP initially every 15 mins, hourly then Monitor BP 4 hourly (1.0) 5. Investigations (Urine for protein, FBC, LFTs, RETS, Uric acid, clotting profile, Ultrasound scan—fetal xxx x | wellbeing, CTE—NST, Fetal kick counts [Any 4 for 1.0 | each] Question 2: On the day of admission, the patientis found || 71 4 to have a BP of 180/120 mmkg and Proteinuria of 3+. \ey OK Outline the major steps of your management apart from we ae s | |Gauk i a. Administer Magnesium sulphate to prevent fits, | carrying out laboratory investiga | © loading dose 14g (4g IV slowly over 5-10min, 10g (5g | \W into each buttock deep intramuscular (4 Marks) | x * Maintenance dose: Give 2.5g into each buttock (i.e fu ct total of 5g every dhrs for 24hrs. (4 Marks)NB: Full description of Pritchard or Zuspan’s method | Monitor the following parameters each time before next dose MgSOx is given | * Patellar reflex (must be present) ~/ \¢ Respiratory rate (must be >16/min) \* | * Hourly urine output (must be >25ml) ~ : * Do not give dose of MgSo4 if patellar reflex is absent: | x give 1g Calcium Gluconate instead || If urine output <100ml in 4hrs, give half the dose of : MgSOs | x b. Control the blood pressure | * by administering IV hydralazine 5-10me over a | period of about 5 minutes. Repeat every 30 mins | till BP is about 150/100mmHg | (OR WV labetalol 20mg over a period of about 1-2 | minutes. Repeat every 30 mins till BP about, | 150/100 mmHg | |. Deliver the woman urgently | * Perform vaginal examination to assess the Bishop's | Score. (2 marks) . © if cervix not favourable, ripen the cervix (2 marks) x ‘© Deliver the baby by C/S if indicated | | what will be your choice of anaesthesia if all other fe parameters are normal? (1 mark) | | Regional anaesthesia |QUESTION 4: Mention four contraindication to your choice of anaesthesia. (1 mark each) Low Platelet level Reduced level of consciousness Spinal problem | Complicated by Abruptio QUESTION 5: a, How soon can she be discharged after delivery? | 72 hours (1 mark) | b. What will be your post-discharge counselling and ‘monitoring? - Toreport if there is any complaints or on the scheduled review dates (1 mark) ~ Review in 1 week with laboratory results (1 mark) ~ Ensure she continues with antihypertensives (1 mark) - Monitor BP for at least 1 year ~ (1 mark) Co whet sh Total per column Penalty marks with reasons | GRAND TOTAL SCORE TOTAL ATTAINABLE MARK: Examiner's name and signature: oes se =DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION 1: HISTORY INSTRUCTIONS FOR THE CANDIDATE THIS WOMAN REPORTS TODAY, FOR THE FIRST TIME TO CR8 IN KATH, WITH A COMPLAINT. KINDLY TAKE A HISTORY FROM HER. AT THE END OF TAKING THE HISTORY YOU WILL PRESENT A SUMMARY OF THE CASE.DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION 1: HISTORY GUIDE TO SIMULATOR ' . ZA HISTORY Presenting complaint Sensation of a mass in vagina—3 months History of presenting complaint A 65-year old Madam VA, P6+2 abortions, who is 12 years postmenopausal, reports to CR8 KATH complaining of feeling of a mass in the vagina and vulva of 6 months’ duration. The feeling of the mass becomes worse in the course of the day as she walks about and also when she defecates or coughs. She sometimes has to manually reduce the mass to achieve complete bladder emptying. On direct questioning: She has no chronic cough or constipation. She has some amount of vaginal discharge with onset of this illness. There is no bleeding per vaginam. She has no chronic constipation. She does not leak urine on coughing or sneezing. There’s no interference with sexual activity. No back pain, no lower abdominal pain * Frequency, urgency, hesitancy, straining, poor stream, feeling of incomplete bladder emptying, splinting (reducing mass to void) but no urinary incontinence * Constipation, straining at defecation, Digitation (manual evacuation of rectum with fingers) © No weight loss Presence of chronic cough, She has waist pains for which she uses herbal preparations. Gynaecologic history She does not remember her menarche but had regular monthly menstrual cycles, during which she bled for 4-5 days. She has been menopausal for past 12 years. Coitarche was at 20 years and she has had 2 lifetime sexual partners. She has never been screened for premalignant lesions of the cervix or breast masses, She has not heard of breast self-examination. She never used any form of contraception and is not on any horméne replacement therapy. She has not been diagnosed of any STIs. Past Obstetric historyAll six pregnancies were carried to term. She had no antenatal care for any of them and deliveries were at home supervised by a TBA. Labours were prolonged. She thinks her babies were big at birth. Breastfeeding for 2 years. Her last two pregnancies spontaneously aborted at 2 months. No EOU was done and there were no complications. Past medical/surgical history: Hypertensive for the past 5 years and diabetic for 2 years. Drug history: She is on antihypertensive and oral anti-diabetic drugs, which names she does not know. She uses herbal preparations for various ailments. She has no known drug allergies. She is not on hormone replacement therapy. Family history: Elder sister is also hypertensive Social history: She is a farmer and married to a 72-year old farmer. She lives at Parkoso near Kumasi with her husband and last child in their own house. She has access to toilet facility and good drinking water. Drinks alcohol occasionally, but does not smoke cigarette. She is still sexually active. She is registered with the NHIA.DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY OSCE STATION 1: HISTORY INDEX NO.. [AcTIVITY MARKS oe Or ie Greeting of patient 1.0 _ x | Self-introduction and explanation of purpose of interaction —1.0 [x] | Demographic data ms Name, age ,etc-1.0 Parity -1.0 LMP --1.0 Presenting complaint ~ | History o "On direct questioning ‘* Chronic cough Constipation z Leakage of urine on coughing or sneezing ~-1.0 | Any difficulty passing urine or faeces --1.0 Able to reduce mass Any vaginal discharge Any bleeding per vaginam --1.0 Any difficulty with sexual intercourse ~-1.0 ‘systems review Cardiovascular—1.0 Genitourina | Gastrointestinal—1.0 CNS—1.0 Respiratory—1.0 | Musculoskeletal (Has wz Gynaecologic history Menarche | Age/ duration of Menopause--2.0 “1.0 ing for breast masses—1.0 "Breast self-examination --1.0 ‘Contraception history --1.0 ‘Any diagnosed STIs --1.0__ Past Obstetric historyMarital status—1.0__ * All pregnancies uneventful -2.0 |x * NOANCfor any ---2.0 . * Home deliveries by TBA ---2.0 x * Prolonged labours 2.0 x * Big babies 2.0 : * Breastfeeding all babies for 2 years --2.0 : * Last 2 pregnancies—spontaneous abortions —-2.0 x * NoEOUforeither --1.0 7 fees No post-abortion complications _ : e Medical/Surgical history — Known HPT and DM x Drug history . . On antihypertensives & hypoglycaemics ---2.0 x Use of herbal preparations 0 x Drug allergies “1.0 x Not on hormone replacement therapy --1.0 x Family history : — aa Sisterhas hypertension --1.0 x Social History . c Occupation—1.0 Place of abode Oo Toilet and water facilities —1.0 Use of alcohol—1.0 _ ‘Smoking—1.0 Sexually active—1.0 Kindly give a concise summary of the history: 65 YR OLD FARMER MADAM VA, P6+2 (SA), KNOWN HPT & DM ON TREATMENT, 12-YR POSTMENOPAUSAL PRESENTING WITH 6-MTH HISTORY OF MASS IN VAGINA/VULVA WITH ASSOCIATED DISCHARGE BUT NO BLEEDING Max 4.0 | Thank You Courtesies Total per column _ oO Penalty mark, if any (Please state reason) ATTAINABLE SCORE =69 — CANDIDATE’S MARK: Examiner’s Name & Signaturebk root Enasmter — Cynmacelssy osce Athen Me m He Clintweh Sconewo cot u (ee motte Wheby Atesnosis Vv Pelvic Ovgan Pw lapse © Cwe v@agon's cohy ge hove Cottled gy (he emo as A Postmenc paused b- Sim presies un Supe te Vagi & Prlongee| — bakaars de By Bow @ fairey pal Alirenio oy outed po be necercarry be dea elic | Ocaminahon jy ter Woman: O Cote es pelap & cel valfelva manny wy im ups he posihes @ 6 pecetiim exam f. type 4 Pye © Check f& CNess nCorbren Ce v chee for Compvotiona UST on Tha prslepte & uleeveKons aa Aho ye » Recto ~ Vagint Seammnahon be dither feted pekeeen Vvecbwtole and enitewce & hon Complicoher of The Condi hen De eca Feria pes, of vased ©pitiatiam a) DB ceubl ul Cera ten i I i i f E E [ f f f | | lapse aol gf yedding+ Hyped phy + elongah ; . ngahen a oe Ke Cowix Usine frac ey a! io i a ae Cincom jolete vading, veer rag upechen ‘ Hy el our cheer + Hyddvo rephvo As the @nix © Mea hen teat op Hons thet Gn be oe thu woreen the mess tear at be be @ ater vasiref prlapse: + WH + Pelme ples vepety 7 cee ef Vaginal pesseres - Menhoo indicohens for use ef veginnl peitence In Sicha Ge © frokepa fumsh wittiin monn delivery © Pa hentt whe ches net coset or 1Rfa ses Surgery *{o elle hme i healing SOY Aecubitiy Weers ee ied) ks palling f+ 4 Rte whe if os loney wer hin Wat- & fugey + Tavoparhe fect, wee 4 uy lgncutt be esata ue syreplors exe chews te a prlapse .| Preven (ee. uv Peo eae “Nobocs F | ale oy Peoges daw ace PE lo My A x Zo ly cs ; . dn Pry pee( 2, mot ) imo | wA~ mf des 9 C Hey ephly chew ) i Yo lanms Vv (Yio ggnom (lootomeel thy yay (ComtoneedDRY OSCE RUN CLASS OF 2021 A SUPPLEMENT 3 cf OBSTETRIC EXAMINATION This station is designed to test the candidate's ability to examine the pregnant woman with emphasis on the uterus in late pregnancy. The candidate is to demonstrate general and abdominal examination. INSTRUCTIONS TO EXAMINER 1 This is a 35 year old Madam CD, G3 P2 both alive by SVD who has been referred to the Komfo Anokye Teaching Hospital on account of prolonged pregnancy at 42weeks +2days. She has no other specific complaints. She perceives fetal movement Her blood pressure today is 120/80mmHg ‘Ask the candidate to carry out a general examination, a complete abdominal examination and any other relevant examination on her Observe the candidate's ability to examine the abdomen completely and his/her relationship with the patient and communication skills Use the checklist to score the candidate appropriately. Award 0 if procedure is net done at all or improperly done The candidate is expected to answer some questions after the examinationOBSTETRICS OSCE STATION 3 INDEX NUMBEI ACTIVITY Greeting client, self-introduction, explanation of purpose of interaction-- Obtain permission to examine her- Comment on general appearance Intention to check Height a : : x Intention to check Weight _ ae ae — [x . Pallor : 2 - - Bee a HoH Anterior neck swellings (inspection, palpation, swallowing) x Ifall steps done—2.0; if not done ‘0’ i | intention to cherkipulce senses — 11x / Intention to check BP Ar Pedal oedema. ‘amine the Breast Intention to If candidate mentions it.... Inspection of abdomen | [esaee seers eee = a Appropriate exposure of the patient's abdomen and standing at the foot end of. | | X | the bed for shape and the moving to the right side of patient for detailed examination | Shape of abdomer “Movements with respiration | Umbilicus (inverted, everted, flat)- Presence or absence of scars/ scarifications | Presence or absence of linea nigra Presence or absence of striae‘Any fetal movements noticed-~ Other skin manifestations/abnormalities Light palpation Ask for site of any pain Maintain eye contact with patient, observing for any tenderness | Correct and orderly palpation of entire 9 regions of the abdomen x Report presence/absence of tenderness Report presence/ absence of any masses Report presence of gravid uterus Deep palpation for organ enlargement liver—1.0 Spleen—1.0 Right kidney—1.0 ‘Left kidney—1.0 Measurement of SFH— 7 Palpation of the uterus using Leopold’s manouvres = —— tit Fundal palpation— Lateral palpation Pelvic palpation— Establishment of descent— “Total per column | GRAND TOTAL | Penalty mark with reason TOTAL ATTAINABLE MARK: stening to fetal heart tones— . | Reporting on findings of uterine examination | Ix Summary of the whole examination findings — xRy DRY OSCE RUN CLASS OF 2021 \/ fl we 1 An SUPPLEMENT 4 be INSTRUCTIONS TO THE CANDIDATE This is a 35 year old Madam CD, G3 P2 both alive by SVD who has been referred to Komfo Anokye Teaching Hospital on account of prolonged pregnancy at 42weeks 2 days. ‘* She perceives fetal movement ‘* Her blood pressure today is 120/80 mmHg © YOU WILL ANSWER SOME QUESTIONS BASED ON THIS SCENARIO OBSTETRIC EXAMINATION POST ENCOUNTER | activity BE ]marKs | QUESTIONS = a o]1)2 7] Briefly outline the principles of management of this woman | a. Counsel on the need for delivery is | b. Inform neonatologist and anaesthetist x | c. Admit patient to ward d. Review patient’s ANC card and conduct investigations as appropriate fe. Investigations 1. Blood: FBC, Blood Group; Rhesus factor, Sickling status (if not done)— 1.0 for each point; total of 4 x | 2. Ultrasound for fetal wellbeing, liquor volume/AFI, placenta location, estimated fetal weight, Biophysical profile (1.0 for each; total of 4) x Cree HST f. Delivery Timing: Immediate or delayed and reasons for choice ( 1 mark for immediate) x] Reason: Immediate: to reduce neonatal morbidity and mortality ) |*Induction of labour, if no obstetric contraindication to vaginal delivery (2.0) Assess Bishop score (2.0) If cervix not favorable, do cervical ripening (2.0) Monitor labour using a partograph ween More frequent intermittent auscultation or continuous fetal heart rate Monitoring if available. | 6. CSif induction fails or there is an obstetric indication | | |x 7. Care of the baby: suctioning of the airways if liquor is meconium stained x 8. Discharge and counselling: Breastfeeding, haby immunization, / | contraception, danger signs of the puerperium, possibility of recurrence x insubsequent pregnancy SSCS | | | Total per column | an I GRAND TOTAL | | L | Penalty mark with reason | | TOTAL ATTAINABLE MARK: Examiner's name and signature: Micha oeDRY OSCE RUN CLASS OF 2021 OBSTETRICS OSCE STATION 3: EXAMINATION INSTRUCTIONS TO THE EXAMINER THIS IS 32-YEAR OLD MS YF, A MULTIPAROUS OF 2, PRESENTING AT 36 WEEKS’ GESTATION AS A REFERRAL FROM HER MIDWIFE ON ACCOUNT OF A PREVIOUS C/SDONE 2 YEARS AGO. SHE HAS NO COMPLAINT TODAY © ASK THE CANDIDATE TO CARRY OUT A GENERAL EXAMINATION, A COMPLETE ABDOMINAL EXAMINATION AND ANY OTHER RELEVANT EXAMINATION ON HER © OBSERVE THE CANDIDATE’S ABILITY TO PERFORM THESE TASKS AND HIS/HER RELATIONSHIP WITH THE PATIENT AND COMMUNICATION SKILLS e USE THE CHECKLIST TO SCORE THE CANDIDATE APPROPRIATELY. Page 1 of 3= DRY OSCE RUN CLASS OF 2021 OBSTETRICS OSCE STATION 3: EXAMINATION INDEX Number... ACTIVITY Greeting client, self-introduction, explanation of purpose of interaction-- Obtain permission to examine her- Comment on general appearance... Intention to check Height Intention to check Weight Pallor Feterus t Anterior neck swellings (inspection, palpation, swallowing) If all steps done—2.0; if not done ‘0’ Intention to check pulse Intention to check BP Pedal oedema Intention to examine the Breast If candidate mentions it.... Inspection of abdomen “Appropriate exposure of the patient’s abdomen and standing at the foot end of the bed for x shape and the moving to the right side of patient for detailed examination Shape of abdomen--- ‘Movements with respiration Umbilicus (inverted, everted, flat)- Presence or absence of scars/ scarifications Presence or absence of lineanigra soars td Page 2 of 3Presence or absence of striae Any fetal movements notice “Other skin manifestations/abnormalties Light palpation — Ask for site of any pain | Maintain eye contact with patient, observing for any tenderness— Correct and orderly palpation of entire 9 regions of the abdomen— Report presence/absence of tenderness Report presence/absence of any masses Report presence of gravid uterus Deep palpation for organ enlargement liver— Right kidney— | Left kidney— Palpation of the uterus using Leopold’s manouvres Measurement of SFH— | Fundal palpation— Lateral palpation Pelvic palpation— = Establishment of descent— Listening to fetal heart tones— | Reporting on findings of uterine examination ‘Summary of the whole examination findings ‘Total per column GRAND TOTAL "Penalty mark with reason Total Mark Attainable Examiner's Name &Signature Page 3 of 3DRY OSCE RUN CLASS OF 2021 OBSTETRICS OSCE STATION 4: POST-ENCOUNTER INSTRUCTIONS TO THE EXAMINER ¢ THIS IS 32-YEAR OLD MISS YF, A MULTIPAROUS OF 2, PRESENTING AT 36 WEEKS’ GESTATION AS A REFERRAL FROM HER MIDWIFE ON ACCOUNT OF A PREVIOUS C/S ~ DONE 2 YEARS AGO. e USE THE CHECKLIST TO APPROPRIATELY SCORE THE \_/CANDIDATE.OBSTETRICS OSCE STATION 4; POST-ENCOUNTER INDEX NUMBER: ACTIVITY QUESTIONS. QUESTION 1: How will you manage her from now till term? ~Review her ANC record book --1.0 ~-Find out reason for previous C/S. --2.0 ~-Decide on definitive mode of delivery -2.0 ~-Request for any of the basic labs that have not yet been done ~ ~-Ask for a check Hb --1.0 ~-Request ultrasound for EFW [1.0] and placental location [1.0] |__=Schedule to see her ina week's time 1.0 a QUESTION 2: What criteria will you use to decide on allowing vaginal delivery? --Non-recurrent indication ~-2.0 --Low transverse uterine incision --2.0 --Singleton pregnancy --2.0 ~-Cephalic presentation --2.0 ~-EFW $ 3.5kg 2.0 ~-Upper segment placentation ~-2.0 --Absence of any other condition likely to preclude vaginal delivery \UESTION 3: Describe how you will manage her when she reports in labour ~-Review her ANC records ~2.0 --Take a history and do a complete physical examination --2.0 --Ascertain presentation is cephalic ~-2.0 ~-Set up IV line and give her Normal Saline --2.0 --Take blood for Hb[1.0] and Cross-match against 2-4 units whole blood --[1.0] --Start her on the partograph if she gets into the active phase --2.0 --Give adequate pain relief --2.0 --Be careful with use of oxytocin for augmentation --2.0 ‘Manage 3” stage actively --2.0 QUESTION 4: what are the obstetric comp | adhesions making abdominal entry difficult Morbid adherence of placenta | Placenta previa | Uterine rupture | increased risk of a repeat CS_ ‘ra courtesies ~~ a ns of a Previous CS? Penalty mark—if any (State reason)DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY STATION 3 INSTRUCTIONS TO EXAMINER The patient is a 35 year old Para 2 +1 whose last child is 8 years old. She complains of heavy and prolonged menstrual bleeding of 6 months’ duration. She has dizziness and palpitations. 1. Ask the candidate to do a general examination and examine the abdomen completely 2. Observe the candidate's ability to do a general examination and examine the abdomen properly, his /her relationship with the patient, his/her attitude and his/her communication skills 3. IF THE CANDIDATE PERFORMS THE ACTIVITY CORRECTLY, PLACE A CIRCLE AROUND [X] IN THE APPROPRIATE COLUMN. SCORE ‘0’ IF ACTIVITY NOT DONE OR IMPROPERLY DONE. 4. Ask the candidate to give a summary of the examination findings INDEX NUMBER .0..s:ssssesssssessssses AChVITY oa ‘Basic courtesies "Greeting, self-introduction and explanation of purpose of interaction-- 1.0 \ | Obtain permission to examine her-~ General examination ‘Comment on general appearance... 20 Intention to check Height Intention to check Height — Hydration - 1.0 Pallor ...1.0 Ieterus ..1.0 Temperature 1.0Respiration 1.0 Anterior neck swellings and lymphadenopathy... 1.0 | Intention to check Pulse | Intention to check Blood Pressure Pedal oedema 1.0 | Intention to examine the breast : if candidate mentions intent to i x) examine and reason 2.0 | Inspection of Abdomen | Appropriate exposure of the patient's abdomen and standing at the foot end of the bed for shape and the moving to the right side of | patient for detailed examination | Shape of abdomen---1.0 [x | Movements with respiration—1.0 Umbilicus (inverted, everted, flat)---1.0 x | Presence or absence of scars/ scarifications—1.0 x Presence or absence of striae—1.0 1 Tx] | Other skin manifestations /abnormalities - 1.0 x| Hair distribution—1.0 xX Palpation Light palpation Ask for site of any pain—1.0 | | X] | Bye contact with patient for any tenderness- 1.0 Correct and orderly palpation of entire 9 regions ofthe abdomen— | |X, 4,0 (score half the mark if incorrectly done) (lel s] Report presence/absence of tenderness— 1.0 x | Report presence of any masses— 1.0 | [x] ae a el Deep palpation for organs _ {Score ‘0’ if improperly done} | Liver—2.0 Tx] | Spleen—2.0 a [x] ‘Right kidney—2.0 Left kidney—2.0 | Palpation of the mass| Palpation from the xiphisternum---2.0 Assessment of parameters of the mass Site ise Surface—2.0 — Consistency and tenderness | | Mobility in 2 planes—2.0 "Attachment to overlying skin—1.0 | __ : - _ Attachment to anterior abdominal wall muscle 1.0 | Ability to go below and above the mass—2.0 _ Differential warmth— 2.0 {en Checking for ascites— 1.0 Reporting on findings of examination of the mass Summary of the whole exai | Thank you courtesies (1 mark) Total per column GRAND TOTAL | Penalty mark with reason TOTAL MARK ATTAINABLE: 68 EXAMINER'S NAME/SIGNATURE:DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY STATION 4: POST-ENCOUNTER EXAMINER'S INSTRUCTIONS Kindly use the checklist to score the candidate based on the clinical scenario below: The patient is a 35 year old Para 2 +1 whose last child is 8 years old. She complains of heavy and prolonged menstrual bleeding of 6 months’ duration. She has dizziness and palpitations. Clinical examination showed that she had a bulky, multinodular fibroid uterus. GYNAECOLOGY STATION 4: POST-ENCOUNTER [activity | MARKS QUESTIONS lolol | QUESTION 1: Discuss your assessment of this patient. el | «Speculum examination: visualize the cervix and exclude local lesions x| ‘© Bimanual pelvic examination x * Haematological investigations: FBC, Sickling, Blood group and Rhesus x status * Pelvic USG: for sizes, number, location and types of fibroids x © Consider endometrial sampling for histology to exclude malignancy and x hyperplasia | ‘ | QUESTION 2: Discuss the options of treatment you would offer this client? le ane x «Consider haemotransfusion if she is anaemic + haematinics x © Consider medical management of menorrhagia:+ Tranexamic aci —— Ea ~ hormonal treatment options: eg. DMPA, mirena IUS | * Surgical options: Uterine conserving methods Endometrial ablation procedures Myomectomy | x ~ Hysterectomy if endometrial cancer or hyperplasia with atypia or | has no fertility wishes | QUESTION 3: How would you minimize blood loss during myomectomy? Strict adherence to heamostasis | | [x | | Reduced number of uterine incisions | x] Use of the Foley’s catheter as a torniquet | x “QUESTION 4: What are the potential effects of fibroids on fertility and [ | pregnancy? (any 5 for 10 marks) Infertility(tubal and endometrial), abortions, wrong dating of pregnancy, | abnormal lie, malpresentations, obstructed labour, prolonged labour, primary Feterblily -Aishrhiy ey enclomehas Gute eect chidtene Shem Wt tb hed TOTAL PER COLUMN | GRAND TOTAL 5 rm | PENALTY MARK WITH REASONS — jean TOTAL MARK ATTAINABLE: 44 EXAMINER'S NAME/SIGNATURE: Sey 1 GN Ks +-£So Tat / - Sie Tl Medpud Pook GA IttDRY OSCE RUN CLASS OF 2021 GYNAECOLOGY STATION 5: IMAGE 1 CANDIDATE’S INSTRUCTION Answer the following questions relating to the image below. os 1. Comment on the Xray picture shown. 2. List indications for the use of the investigation shown in this picture. 3. Outline how this investigation is done. 4. List complications associated with the investigation shown in the picture?DRY OSCE RUN CLASS OF 2021 GYNAECOLOGY STATION 5: IMAGE 1. EXAMINER'S INSTRUCTION The candidate will answer following questions relating to the image below. Score the candidate based on the scheme below 1. Comment on the Xray picture shown. (4 marks) 2, List indications for the use of the investigation shown in this picture. (Any 4 for 4 marks) 3. Outline how this investigation is done. (7 marks) 4. complications associated with the investigation shown in the picture? (Any 4 for 4 marks) SCHEME 1 Comment on the Xray picture shown. (4 marks) Hysterosalpingogram (1) Normal uterine shape (1) and size (1) Both tubes outlined (1)ere cry EN ne W* i cy Bilateral spillage of dye (1) 2 List indications for the use of the investigation shown in this picture. (Any 4 for 4 marks) Investigation of infertility Suspected Ashermann’s syndrome Recurrent abortions ~to exclude werine anomaly), wot! & (fod Ceri cg olny (ote d (fhe I etm 3 Outline how this investigation is done. (7 marks)“. oc he 4 The test uses an iodine contrast agent pransco® ‘ = Clean vulva, vagina and cervix ~ Pass a Cusco’s speculum yo Insertion of a thin flexible catheter into the uterus \% Inflation of balloon at the tip to prevent leakage of the contrast / “Alternately, a Leech-Wilkinson metal cervical catheter is inserted and * screwed into place a . Pre-injection X-ray image is taken , Contrast is injected ‘\ Series of X-ray images are taken to visualise passage of the contrast through « the uterus and fallopian tubes « Xtays are then reviewed 4 List complications associated with the investigation shown in the picture? (Any 5 for 5 marks) Pelvic pain Chemical peritonitis Acute PID Allergic reaction to contrast medium Vasovagal reaction with bradycardia and hypotension, potentially resulting in syncope Uterine perforation Embolic phenomena bee. frohpeatve phec Yn Bets, Conbaunciteben { Pade a Cunpecteot Kreg ny on ee oe he ! oA Jrpecho (eediabe Plog’ | ; u Acute fede Infecer Keys Clletir (Lolicon | y bohw* vend weleor f ecr ins P _ — bylekehor mf Gectey ie Roce : ot: C2APItASs PCg. Jame Ie® por pOHE news d hse jbo we Blgey MC, (at Gunelby 02022634 OOK B10,Contrast Medd Let A —_———— Legere Goletle Cmhur- Luteunr G A bia Aubezy\ Comer 5 D ES tated abinenelihes Ta shepe 74em abe cons lies Baa | - becom 260) PKDRY OSCE RUN CLASS OF 2021 FOR CANDIDATE Ms Adabie, 22 years, was admitted to the labour ward of KATH on January 18, 2019 at 8.00am. She complained of lower abdominal pains that started 4 hours prior to admission. She had ruptured ‘membranes an hour before arrival in hospital. She is G2P1 by SVD, alive and is 38 weeks pregnant On admission, she looks well, not pale and has BP of 120/80mmHg. Her temperature is 36.5°C and pulse 90 beats. She is having 2 contractions each lasting 20 seconds. Presentation is cephalic with descent of 4/5. Fetal heart tones are present and regular at 140 beats per minute. The cervix is effaced and 4.0cm dilated. There is no caput and no moulding and liquor is clear. 08.30am: FH 130, Contractions 2/10 lasting 30sec, Pulse 80 09.0am: FH 140, Contractions 2/10 lasting 30 sec, Pulse 90 09:30am: FH 136, Contractions 2/10 lasting 30sec, Pulse 80 10.00am: FH 146, Contractions 2/10 lasting 30sec, Pulse 80 10.30amj-FH 140, Contractions 2/10 lasting 30sec, Pulse 90 11.00am: FH 130, Contractions 3/10 lasting 30sec, Pulse 80 12.00no0n Descent is 3/5, FH 140, Contractions 3/10 lasting 30sec. Pulse 90; urine output is 300ml, clear; negative for protein and ketones. BP 120/90. Temperature 37.4°C Cervix is 5.0cm dilated, no caput, position LOA, no moulding; Question 1. Plot these on a partograph 2. From the graph, what is your diagnosis? 3. Whats the likely reason for this? 4. What will be the appropriate interventions at this stage in labour? testa choFOR EXAMINER: Partograph Ms Adabie, 22 years, was admitted to the labour ward of KATH on January 18, 2019 at 8.00am. She complained of lower abdominal pains that started 4 hours prior to admission. She had ruptured membranes an hour before arrival in hospital. She is G2P1 by SVD, alive and is 38 weeks pregnant. On admission, she looks well, not pale and has BP of 120/80mmHg. Her temperature is 36.5°C and pulse 90 beats. She is having 2 contractions each lasting 20 seconds. Presentation is cephalic with descent of 4/5. Fetal heart tones are present and regular at 140 beats per minute. The cervix is effaced and 4.0cm dilated. There is no caput and no moulding and liquor is clear. 08.30am: FH 130, Contractions 2/10 lasting 30sec, Pulse 80 09.00am: FH 140, Contractions 2/10 lasting 30 sec, Pulse 90 09.30am: FH 136, Contractions 2/10 lasting 30sec, Pulse 80 10.00am: FH 146, Contractions 2/10 lasting 30sec, Pulse 80 10.30am: FH 140, Contractions 2/10 lasting 30sec, Pulse 90 11.00am: FH 130, Contractions 3/10 lasting 30sec, Pulse 80 12.00no0n Descent is 3/5, FH 140, Contractions 3/10 lasting 30sec. Pulse 90; urine output is 300ml, clear; negative for protein and ketones. BP 120/90. Temperature 37.4°C Cervix is 5.0cm dilated, no caput, position LOA, no moulding; Question 1. Plot these on apartograph (6 MARKS; FH 1 MARK, CERVICOGRAM 2 MARKS, CONTRACTION 2 MARKS, MATERNAL VITALS 1MARK) 2. From the graph, what is your diagnosis? SLOW PROGRESS IN LABOUR (1 MARK) 3. What is the likely reason for this? Inadequate uterine contractions (1 MARK) 4. What will be the appropriate interventions at this stage in labour? (2 MARKS) Augmentation of labourrk re Aue a thet : v Morn Reveahe — Pret. ont Potton, Ca Wecondony Reecthin ie con oe o leben freverhen Pw Rktel— Avi ~ v he Yl Nase in Pregrensy + coher 1p gel ) de mm ecdenk Vag nont “ DS ietquelt ety Colo Lic ter qty Cave } Gs Copp gan Camel aappes ane Apes net ctanl, donned , f 7 PD ee Aa de - Pe ube ( Petcare Lydue ~<** PH aS 7 My coplesm - ee ee feet = pala lincas Green Uveplemne Uve Lylrou, = Mehsana Bae 4 (Lh DergDRY OSCE RUN CLASS OF 2021 GYNAECOLOGY STATION 7: IMAGE 2 CANDIDATE INSTRUCTION Answer the following questions relating to the image below. a a Qn 1: Identify this device Qn 2: What is the active agent in this device? Qn 3: When can it be administered and explain its mechanism of action? Qn 4: Describe how you would administer this device on a client who opts for it after counselling 2 $ o : List the advantages and drawbacks associated with its use.mec Wiis Keuht B_ gen rte luhewenbmert. —Apat wnerloye lneu 1 wee debvey kode hear oF dhl Gude Sch (Sc) @ Bware years Pl (SRY Lyrae Bone porn [heck pare! Ea Schou durahen: — hae Cage pa hk dew ¢ Pa Pil be Mom a ony ae be pera pumped eter Ceeete) amedy auido duu ¢ veperted Vee feb CWillme loe polory Bote, ID Ayn he fs- rgen whogncte cpegenehon- “Ofek of co | hie